Emphysematous cystitis

Emphysematous cystitis - X-rax - SHF

Emphysematous cystitis is a rare form of cystitis characterized by the presence of gas within the bladder wall and lumen. This condition is typically caused by a bacterial infection that produces gas, leading to the accumulation of gas in the bladder tissues.

Etiology

Emphysematous cystitis is most commonly caused by Escherichia coli and Klebsiella pneumoniae, although other gas-forming organisms such as Proteus mirabilis, Enterobacter aerogenes, and Candida albicans can also be responsible. The condition is more prevalent in individuals with diabetes mellitus, urinary tract obstruction, or immunosuppression.

Pathophysiology

The pathophysiology of emphysematous cystitis involves the fermentation of glucose and other substrates by gas-forming bacteria, leading to the production of gas. This gas accumulates in the bladder wall and lumen, causing the characteristic radiographic findings.

Clinical Presentation

Patients with emphysematous cystitis may present with symptoms similar to those of typical urinary tract infections, including dysuria, hematuria, frequency, and urgency. However, some patients may be asymptomatic or present with nonspecific symptoms such as abdominal pain, fever, and malaise.

Diagnosis

The diagnosis of emphysematous cystitis is primarily made through imaging studies. Computed tomography (CT) is the most sensitive and specific imaging modality, revealing the presence of gas within the bladder wall and lumen. Plain radiography and ultrasonography can also be used but are less sensitive.

Treatment

The treatment of emphysematous cystitis involves a combination of antibiotic therapy and management of underlying conditions such as diabetes. Broad-spectrum antibiotics are typically initiated empirically and later tailored based on culture results. In severe cases, surgical intervention may be necessary to remove necrotic tissue or to address complications such as bladder rupture.

Prognosis

The prognosis of emphysematous cystitis varies depending on the severity of the infection and the patient's underlying health conditions. Early diagnosis and appropriate treatment are crucial for a favorable outcome. Complications can include sepsis, bladder rupture, and renal failure.

See also

• Cystitis
• Urinary tract infection
• Diabetes mellitus
• Escherichia coli
• Klebsiella pneumoniae